The menace of caesarean scar pregnancy: a management challenge in modern obstetrics

Background: With the increasing caesarean section rates a new challenging evil of caesarean scar pregnancy (CSPs) has emerged. As a variant of ectopic pregnancy caesarean scar pregnancy is the rarest of all. Diagnosis and management of CSP can be challenging especially when there are no early symptoms and even lessor index of suspicion.  Objective of this endeavour was to present one institute experience of management of caesarean scar pregnancies.Methods: This are a retrospective analysis of women admitted with CSP. Detailed history, investigation, management protocols and complications were noted.Results: Of the total cases maximum women (60%) had history of previous two caesarean section. 90 % of cases were managed successfully with intra-sac or systemic methotrexate, and surgical evacuation with Foley’s catheter tamponade, only two women needed hysterectomy for uncontrolled bleeding.Conclusions: Caesarean scar pregnancy is a diagnostic and management challenge in modern obstetrics. Early ultrasound diagnosis helps in planning a successful medical treatment and serves to preserve uterus and fertility. Treatment with transabdominal intra-sac methotrexate and Foley’s catheter for tamponade is safe and effective method of treating CSPs.

Assessment of Nutritional Status of Sputum Positive Pulmonary Tuberculosis Patients in a Medical College

Introduction: Tuberculosis (TB) has been understood as a disease of wasting since it causes significant deficiencies in nearlyevery nutritional marker.Aims and Objective: The purpose of this study is to assess the nutritional status of patients of sputum positive pulmonary TBpatients and to identify the factors if malnutrition is present.Materials and Methods: Two hundred patients of sputum positive for pulmonary TB were selected in a medical college on anoutpatient service basis. The most common nutritional and biochemical assessment was done by blood hemoglobin and serumalbumin level. All other relevant parameters were also recorded.Results: About 10.5% of patients of severe anemia, 20% of patients of moderate anemia, and 35.5% of patients of mild anemiawere found. About 12.5% cases of severe albumin deficiency (<2 g/dl), 24.5% cases of moderate albumin deficiency (≤2.5 g/dl),and 37% cases of mild albumin deficiency (≤3 g/dl) were also noted. There was a significant correlation between decreasecalorie intake and decrease albumin levels. In the rural population, there were 79.16% malnourished in <20 years age group.Male preponderance (66%) was noted with male:female ratio of 2:1. About 86.5% of the patients were illiterate. About 87% ofpatients belong to lower social class. About 37% of cases were smoker and out of these smokers, 71% were malnourished.About 35% of cases were alcoholic and out of these alcoholic, 71% were malnourished.Conclusion: Sputum positive TB patients have poor nutritional status. Malnutrition is found in individuals with factors of ruralbackground, male patients, poor literary status, low family income, smoking, and alcohol addiction.

Bilateral ectropion in a 3 months old baby with lamellar ichthyosis: a rare case report.

Ichthyosiform dermatoses are a group of hereditary disorders characterized by dryness and roughness of the skin with excessive accumulation of epidermal scales. Four main types of Ichthyosis are Ichthyosis vulgaris, x-linked recessive, lamellar ichthyosis and epidermolytic hyperkeratosis. Lamellar ichthyosis is the rarest form with an incidence of 1 in 3, 00,000. It has autosomal recessive inheritance. Ocular manifestations include exposure keratitis secondary to ectropion, unilateral megalocornea, and enlarged corneal nerve, and blepharitis, absence of the meibomian gland, trichiasis, madarosis and absence of lacrimal puncta. Ectropion of both upper and lower lids have been documented. We are reporting a rare case of lamellar ichthyosis with bilateral upper eyelid ectropion in a child.

Schneiderian First Rank Symptoms and Gamma Oscillatory Activity in Neuroleptic Naive First Episode Schizophrenia: A 192 Channel EEG Study

OBJECTIVE: Schneiderian first-rank symptoms (FRS) and abnormal EEG gamma activity in schizophrenia have been reported independently to have a neurodevelopmental basis. We aimed to investigate spontaneous gamma power in two groups of first episode schizophrenia patients (those who experience FRS and those who do not). METHODS: A comparative hospital based study having 37neuroleptic naive male patients with schizophrenia divided into two groups-FRS(+) and FRS(-) groups based on the presence of FRS. Thirty age, sex, education and handedness matched individuals served as controls (N). All participants underwent a 192-channel resting Electroencephalography (EEG) recording. Gamma spectral power was calculated for low- (30-50 Hz) and high-gamma 1 & 2 (51-70 and 71-100 Hz) bands. Spectral power was compared between three groups using MANOVA and supplementary one-way ANOVA with Bonferroni test controlling for multiple comparisons. Linear regression was used to identifying predictor variables for FRS. Pearson correlation coefficient was computed between spectral power parameters and various clinical variables. RESULTS: Significantly higher high gamma band-1 power was observed over right frontal (p<0.05), parietal (p<0.05) and temporal (p<0.05) regions in FRS(+) than FRS(-) group and normal controls. Right parietal high gamma-1 power and paranoid cluster on PANSS significantly predicted number of FRS in total schizophrenia patients; paranoid cluster on PANSS showed significant correlation with number of FRS in FRS(+) group. CONCLUSION: Findings of our study add to the evidence that areas contained within the hetero modal association cortex are associated with FRS. The study findings also strengthen the neurodevelopmental basis of FRS in schizophrenia.

Testosterone and estradiol-17b dependent phospholipid catfish, Heteropneustes fossilis (Bloch)biosynthesis in ovariectomized.

Effect of cumulative doses (7, 14 and 28 mgkg-1 body weight) of testosterone (T) and estradiol-17b (E2) on total phospholipids (TP), phosphatidylcholine (PC), phosphatidylserine (PS), phosphatidylinositol (PI) and phosphatidylethanolamine (PE) in tissues were investigated during the gonadal recrudescence, in prespawning phase of the annual reproductive cycle in intact and ovariectomized freshwater catfish, Heteropneustes fossilis. After ovariectomy, the hepatic levels of TP and PE were elevated and remained unaffected for PC, PS and PE when compared with control. In general, T and E2 were stimulatory for a specific class of phospholipid in tissues of intact and ovariectomized catfish. These effects were higher at 14 and 28 mg kg-1 body weight in ovariectomized catfish whereas 7 mgkg-1 body weight of T and E2 have pronounced effect in intact ovaries. In conclusion, the various phospholipid biosynthesis were under T and E2 dependent. Among the phospholipid, the PC was the main constituent and was sex steroid dependent biosynthesis during prespawning phase.

Effects of estradiol-17beta and 17alpha, 20beta-dihydroxy-4-pregnen-3-one on different phospholipids metabolism and histological changes in ovary during reproductive growth in the catfish, Heteropneustes fossilis (Bloch).

Effect of cumulative doses of estradiol -17beta (E2-7, 14 and 28 mg/kg body weight) and 17alpha, 20beta-dihydroxy-4-pregnen-3-one (17alpha,20betaP-7, 14 and 28 mg/kg body weight) on total phospholipids (TP) and various phospholipids- phosphatidylcholine (PC), phosphatidylserine (PS), phosphatidylinositol (PI) and phosphatidylethanolamine (PE) on liver plasma and ovary were investigated during the reproductively active preparatory and prespawning phases of the annual reproductive cycle in the freshwater female catfish, H. fossilis. The effect of E2 on TP was generally stimulatory and has pronounced effect than 17alpha,20betaP during both the phases. The levels of PC was promoted high during prespawning phase by E2 comparatively very less than by 17alpha, 20betaP in studied tissues during both the phases. The levels of PS after E2 treatments was maximum in all tissues during prespawning phase whereas 17alpha,20betaP was effective only in liver during this phase. The PI was elevated in liver during preparatory phase but its elevation was in all studied tissues during prespawning phase after E2 treatments. The levels of PI was most effective in ovary during preparatory phase in response to 17alpha,20betaP. The levels of PE was declined in liver but elevated in ovary after E2 treatments during both the phases. Treatments of E2 during preparatory phase showed greater number of vitellogenic oocytes as compared to 17alpha,20betaP treatments. The present finding has demonstrated that estradiol-17beta has more pronounced effects than the 17alpha,20beta P in regulation of different phospholipids and ovarian recrudescence during reproductively active phases and among the phospholipids the PC is the main phospholipids of vitellogenin/ovarian lipids in H. fossilis.

Multiple pulmonary nodules.

A 48-year-old post-menopausal female was referred to us in view of her chest radiograph showing multiple pulmonary nodules (Figure 1). She complained of fever and arthralgia since one month. She had been diagnosed as allergic rhinitis with mild episodic asthma since childhood on the basis of symptomatology and was on inhaled steroids and bronchodilators for the same. There was no history of receiving oral corticosteroids or leukotreine antagonists for asthma. Clinical examination did not reveal any abnormality.